Long-Term Effects of Low-Density Lipoprotein Apheresis Using an Automated Dextran Sulfate Cellulose Adsorption System fn1fn1This study was supported by a grant from the Kaneka America Corporation, New York, New York.

Gordon, Bruce R.; Kelsey, Sheryl F.; Dau, Peter C.; Gotto, Antonio M.; Graham, Kevin J.; Illingworth, D. Roger; Isaacsohn, Jonathan L.; Jones, Peter H.; Leitman, Susan F.; Saal, Stuart D.; Stein, Evan A.; Stern, Thomas N.; Troendle, August; Zwiener, Robert J.

doi:10.1016/s0002-9149(97)00947-8

Cited by 101 publications

(15 citation statements)

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“…This is most likely explained by the very low frequency of adverse events of < 3% during HELP apheresis. This data is similar to experiences published by other authors who reported 3.6% in adults and 3% in children [28,29]. In particular, major problems like severe arrhythmia or inflammatory diseases causing further in-hospital treatment did not occur.…”

Section: Discussionsupporting

confidence: 91%

HELP apheresis in hypercholesterolemia and cardiovascular disease: efficacy and adverse events after 8,500 procedures

Buuren

Kreickmann

Horstkotte

et al. 2012

Clin Res Cardiol Suppl

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IntroductionLow density lipoprotein (LDL-C) apheresis is a last treatment option for hypercholesterolemic patientsresistant to conservative lipid-lowering therapy. In a retrospective analysis of 8,533 heparin-induced extra-corporeal LDL precipitation apheresis treatments (HELP), we evaluated the efficacy of LDL reduction, the rate of adverse events, and the progression of atherosclerosis.MethodsBetween July 1992 and April 2009, we performed 8,533 HELP apheresis therapies in patients with familial hypercholesterolemia (FH). Inclusion criteria were FH with insufficient lipidological status under optimal drug therapy and diet, and at least 50 HELP therapies. Left ventricular function and valvular status was checked prior to the first apheresis therapy and at the end of the individual HELP program. Blood samples were taken directly before and after each therapy. Blood count, electrolytes, total cholesterol, LDL–C, high density lipoprotein (HDL–C), triglycerides, lipoprotein (a) (Lp(a)), and fibrinogen were measured. Adverse events were documented weekly.ResultsWe evaluated 27 patients (19 men) with FH (age 49.2 ± 12.5 years (range 10–67 years)). The number of HELP treatments once weekly was between 50 and 790 applications. Mean follow-up time was 7.0 ± 5.2 years (range 1.3–16.6 years).Prior to the individual apheresis program, 44.4% of the patients had a three vessel disease (VD; 25.9% two VD, 25.9% one VD) and 7.4% had a peripheral arterial occlusive disease. During the time of HELP treatment, none of the patients had a myocardial infarction; 3.7% had one percutaneous coronary intervention (PCI), 11.1% two PCI, 14.8% three PCI, 11.1% ³ four PCI.The patients received 1.2 ± 1.6 (range 0–5) PCI during follow-up time. Adverse events directly associated with HELP therapy were very rare (< 3%). Mean elimination of LDL-C was 63.49 ± 7.1%.DiscussionThe HELP apheresis therapy was well accepted by the patients in our programs. Adverse events during HELP apheresis were rare. This data is in line with the experiences published by other authors who reported an adverse event rate of 3.6% in adults. The LDL-HDL ratio, one of the strongest predictors of premature CHD events, improved significantly during the apheresis program.ConclusionHELP is a safe, comfortable, and highly effective treatment in which adverse events are rare. It can reduce the burden of atherosclerosis, with no myocardial infarction and a low coronary intervention rate in our patients.

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Section: Discussionsupporting

confidence: 91%

HELP apheresis in hypercholesterolemia and cardiovascular disease: efficacy and adverse events after 8,500 procedures

Buuren

Kreickmann

Horstkotte

et al. 2012

Clin Res Cardiol Suppl

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“…www.expert-reviews.com An American group reported that the rate of cardiovascular events during therapy with LDL apheresis and lipid-lowering drugs was 3.5 events per 1000 patient-months of treatment compared with 6.3 events per 1000 patient-months for the 5 years before LDL apheresis therapy [54].…”

Section: Special Reportmentioning

confidence: 99%

Comparison of different LDL apheresis methods

Julius¹,

Frind

Tselmin

et al. 2008

Expert Review of Cardiovascular Therapy

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This article presents the generally accepted indications for LDL apheresis treatment. The available LDL apheresis methods differ with respect to acute relative reductions of LDL cholesterol; mean values after the LDL apheresis treatments are not different. Serum triglycerides, HDL-cholesterol, and lipoprotein(a) are also acutely reduced. Available LDL apheresis methods differ with respect to their impact on the coagulation system, on C-reactive protein and on leukocyte count. Cardiovascular events are clearly reduced by the LDL apheresis methods. There is an urgent need to prospectively compare the different LDL apheresis methods taking into account hard end points. The lower target values for LDL cholesterol suggested by international guidelines for high-risk patients will certainly require a more widespread use of LDL apheresis.

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“…Thus, it is not recommended as the procedure of choice. The most common selective LDL apheresis methods available today include LDL cholesterol adsorption to dextran sulfate attached to cellulose (DSA) [3], heparin-mediated extracorporeal LDL precipitation (HELP) [4], direct adsorption of lipoprotein (DALI) [5], and LDL immunoadsorption [6]. These methods differ from each other in several aspects that may have an impact on their selectivity and effectiveness in LDL elimination.…”

Section: Introductionmentioning

confidence: 99%

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Hershcovici

Schechner

Orlin

et al. 2004

J of Clinical Apheresis

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LDL-apheresis lowers the LDL level in patients with severe hypercholesterolemia. The present study compared three apheresis methods--DSA, DALI, and plasma exchange--for effectiveness in removal of LDL and effect on various blood parameters involved in atherogenesis. The study group included 6 patients with primary hypercholesterolemia unresponsive to maximal drug therapy. All were treated first with 4 consecutive plasma exchange sessions followed by 4 DSA sessions; in four out of six, an additional 4 sessions of DALI were then performed. Levels of lipoproteins, apoproteins, CRP, homocysteine, fibrinogen, and blood count were determined before and after each session. All 3 procedures yielded a significant reduction in total cholesterol and ApoB-containing lipoproteins, with DALI being the most effective. Also, a significant reduction in triglycerides, HDL, and ApoA1 was observed with all the methods. The reduction in HDL-C with DSA and DALI was greater than previously reported. The LDL/HDL-cholesterol ratio decreased significantly with DSA and DALI and increased with plasma exchange. There was a significant decrease in CRP, fibrinogen, and platelets with all three methods, and a significant decrease in homocysteine only with DSA and DALI. All three procedures effectively reduced the concentration of various compounds involved in atherosclerosis. Plasma exchange is nonselective and cannot be recommended as the procedure of choice.

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Long-Term Effects of Low-Density Lipoprotein Apheresis Using an Automated Dextran Sulfate Cellulose Adsorption System fn1fn1This study was supported by a grant from the Kaneka America Corporation, New York, New York.

Cited by 101 publications

References 12 publications

HELP apheresis in hypercholesterolemia and cardiovascular disease: efficacy and adverse events after 8,500 procedures

HELP apheresis in hypercholesterolemia and cardiovascular disease: efficacy and adverse events after 8,500 procedures

Comparison of different LDL apheresis methods

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

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